R. E. Wittenberg1, N. Z. Shimelash2, O. Masimbi2, M. Bryce-Alberti3, M. Carroll3, S. R. Nuss3, M. T. Hey3, R. Jhunjhunwala4, C. Forbes3, B. T. Alayande5, G. A. Anderson3 1Harvard Medical School, Boston, MA, USA 2University of Global Health Equity, Simulation And Skills Center, Butaro, Rwanda 3Program In Global Surgery And Social Change, Harvard Medical School, Boston, MA, USA 4Beth Israel Deaconess Medical Center, Department Of Surgery, Boston, MA, USA 5University of Global Health Equity, Center For Equity In Global Surgery, Butaro, Rwanda
Introduction: Simulation-based training (SBT) enhances medical education but is often limited in low-resource settings. We developed, implemented, and assessed three low-cost, medium-fidelity SBT models of soft-tissue lesions for medical students beginning their general surgery clerkship in Rwanda.
Methods: Models were designed for three common procedures identified by clerkship operative logs and a Delphi process identifying priority procedures for medical students: (1) abscess drainage with/without ultrasound guidance (Fig.1A); (2) biopsy/excision of subcutaneous mass/nodule (Fig.1B); and (3) wound debridement (Fig.1C). The nodule and abscess models were practiced with/without portable ultrasound. Nearly all materials were locally-sourced and included items such as sponges, gelatin, felt, and pieces of latex gloves filled with lotion. The curriculum was implemented via partnership between U.S. and Rwandan healthcare providers. A short lecture preceded guided simulation in pairs. Pre- and post-assessments using Likert scales assessed students’ exposure, interest, and confidence in these skills.
Results: Of the 18 medical students who participated, few had previously observed nodule excision (6%), abscess drainage (6%), or wound debridement (24%), and 0% had performed any of these procedures. 88% had practiced ultrasound prior to the session. >80% reported being “very interested” in each procedure. On a five-point scale, student confidence in skill performance improved +1.85 (p<0.001) for wound debridement, +1.72 (p<0.001) for nodule excision, and +1.31 (p<0.001) for abscess drainage and was >4.1/5.0 for all procedures post-session. Most students rated the models “somewhat representative” and strongly agreed that the models were useful (94%) and anticipated using these skills in future training/practice (75%). 100% reported enjoying the session. The nodule excision model was most popular. Cost/unit was $1.19 for the abscess, $1.07 for the nodule, and $1.17 for the wound debridement models.
Conclusion: Simulation using low-cost, locally-sourced models increased student confidence in three common procedures for soft-tissue lesions. SBT can augment medical training in low-resource settings. While designed for a general surgery clerkship, these models could be utilized for training in a variety of procedural settings and adapted to target diverse learners with varied skill levels.
